Increased Risk of Osteoporosis in Gastric Cancer Survivors Compared to General Population Control: A Study with Representative Korean Population / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although several studies have suggested that osteoporosis is common in survivors of gastric cancer (GC), no study to date has directly assessed the risk for osteoporosis in GC survivors compared to matched controls. Thus, we aimed to investigate the relative risk for osteoporosis in survivors of GC compared to general population. MATERIALS AND METHODS: We used the Korea National Health and Nutrition Examination Survey data (2008-2011). Patients with a history of GC (n=94) were defined as case among 8,142 individuals over 50 years old who were evaluated by dual-energy X-ray absorptiometry. Controls (n=470) were matched to cases by age and sex in a 1:5 ratio. Osteopenia (–2.5 < T-score < –1.0) and osteoporosis (T-score ≤ –2.5) were defined. RESULTS: The prevalence of osteoporosis in GC survivors was 30.2%, which was significantly greater than that of controls (19.7%). In total, GC survivors had a 3.7-fold increased risk for osteoporosis compared to controls (p=0.021). In addition, the risk for osteoporosis of the total proximal femur total (TF) and femur neck (FN) was significantly increased among GC survivors compared to controls (adjusted relative risk, 4.64; 95% confidence interval, 1.16 to 18.6 in TF and adjusted relative risk, 3.58; 95% confidence interval, 1.19 to 10.8 in FN). Furthermore, we found sub-optimal daily calcium intake and mean serum levels of 25-hydroxy-vitamin D in both groups. CONCLUSION: GC survivors are at significantly increased risk for osteoporosis, especially in the femur. Clinically, our finding supports the importance of screening bone health and adequate nutrient supplementation in survivors of GC.

One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.